BACKGROUND METHODS RESULTS CONCLUSIONS
|
|
- Clementine Floyd
- 6 years ago
- Views:
Transcription
1 CHAPTER 5 The combination of a normal D-dimer concentration and a non-high pretest clinical probability score is a safe strategy to exclude deep venous thrombosis R.E.G. Schutgens 1, P. Ackermark 2, F.J.L.M. Haas 3, H.K. Nieuwenhuis 4, H.G. Peltenburg 5, A.H. Pijlman 2, M. Pruijm 5, R. Oltmans 6, J.C. Kelder 7, D.H. Biesma 1. Departments of 1 Internal Medicine, 3 Clinical Chemistry and 7 Research and Development, St. Antonius Hospital, Nieuwegein; 2 Internal Medicine, Diakonessenhuis, Utrecht; 4 Haematology, University Medical Centre, Utrecht; 5 Internal Medicine, Groene Hart Hospital, Gouda; 6 Internal Medicine, Mesos Medical Centre, Utrecht; The Netherlands
2 SUMMARY BACKGROUND Serial ultrasonography is reliable for the diagnosis of deep venous thrombosis in symptomatic patients, but the low prevalence of thrombosis in this group renders this approach costly and inconvenient to patients. We studied the clinical validity of the combination of a pretest clinical probability score and a D-dimer test in the initial evaluation of patients suspected of deep venous thrombosis. METHODS Patients with a normal D-dimer concentration (< 500 FEU µg/l) and a non-high probability score (< 3) had no further testing. Patients with a normal D-dimer concentration and a high probability score ( 3) underwent one ultrasonography. Serial ultrasonography was performed in patients with an abnormal D-dimer concentration. Patients were followed for 3 months. RESULTS A total of 812 patients were evaluable for efficacy. Only 1 of 176 patients (0.6%; 95% CI: %) with a normal D-dimer concentration and a non-high probability score developed thrombosis during follow-up. A normal D-dimer concentration and a high probability score were found in 39 patients; 3 of them (7.7%; 95% CI: %) had thrombosis at presentation, and one (2.8%; 95% CI: %) developed pulmonary embolism during follow-up. In 306 of 597 patients (51.3%) with an abnormal D-dimer concentration, thrombosis was detected by serial ultrasonography. Six patients (2.1%; 95% CI: %) developed thrombosis during follow-up. No deaths due to thromboembolism occurred during follow-up. The total need for ultrasonography was reduced by 29%. CONCLUSIONS The combination of a non-high pretest clinical probability score and a normal D-dimer concentration is a safe strategy to rule out deep venous thrombosis and to withhold anticoagulation. 52
3 The AIDA study INTRODUCTION Deep venous thrombosis can be diagnosed or rejected accurately by serial compression ultrasonography. In two studies with a follow-up period of, respectively, 3 and 6 months, venous thromboembolic complications were found in only 0.6% and 0.7% of patients with suspected deep venous thrombosis after normal serial ultrasonography (1;2). Serial ultrasonography, however, is inefficient because only 17 to 24% of patients suspected for deep venous thrombosis actually has it (1-6), and only 0.9% develop it after the initial normal ultrasonogram (2). Other non-invasive diagnostic tests, such as the pretest clinical probability score (5-7) and the D-dimer measurement (4;7-14), are subject of studies to reduce the need for ultrasonography. It has been proven safe to withhold anticoagulant treatment in patients with a low pretest clinical probability score and normal initial ultrasonogram (6) and in patients with a normal D-dimer and normal ultrasonography at first presentation (3;11;14). The next step, which is the subject of the present study, is to investigate the safety of the combination of a non-high pretest clinical probability score and a normal D-dimer to replace of ultrasonography as the initial test in the diagnostic management of patients suspected of having deep venous thrombosis. chapter 5 53
4 PATIENTS AND METHODS Patients This investigation was a prospective cohort study in 4 large, nonacademic, teaching hospitals in the Netherlands. All outpatients with clinical symptoms of deep venous thrombosis of the leg, who were referred by their general practitioners, were potentially eligible for the study. Exclusion criteria were pregnancy, previous deep venous thrombosis in the ipsilateral leg without documentation of recanalization, a concomitant clinical suspicion of pulmonary embolism, the use of unfractionated heparin, low-molecularweight heparin or any form of oral anticoagulant in the past month, geographic impossibility for follow-up and life expectancy less than 3 months. Patients entering the study were asked for informed consent. The medical ethical committees of the participating centers approved the study. Methods Eligible patients who gave informed consent were assessed by one of the study physicians or local residents and a single pretest clinical probability score according to Wells et al was performed (5). Patients were considered to have a low or moderate ( non-high ) suspicion for having deep venous thrombosis when the score was < 3 and at high suspicion when the score was 3. We performed the Tina-quant quantitative latex D-dimer assay (Roche, Germany) in all patients. Previous reports have validated this test using venography (12;15). An abnormal test was defined as a D-dimervalue > 499 Fibrin Equivalent Units (FEU) µg/l. The pretest clinical probability score was performed by physicians who were not previously aware of the D-dimer concentration. Ultrasonography, using real-time B-mode with compression, was done with a 7.5 MHz and/or a 5.0 MHz transducer. Two areas of the leg were examined: the common femoral vein at the inguinal ligament and the popliteal vein at the knee-joint line traced down to the point of the trifurcation of the calf veins. Veins were scanned in the transverse plane only. Lack of compressibility was the sole criterion for an abnormal result; a vein was considered fully compressible if no residual lumen was seen. Patients with a non-high pretest clinical probability score and a normal D-dimer concentration had no further investigations (Figure). The patients with a high pretest clinical probability score and a normal D-dimer concen- 54
5 The AIDA study tration underwent a single ultrasonogram at presentation. Patients with an abnormal D-dimer concentration (irrespective their pretest clinical probability score) had repeated ultrasonography (with a second ultrasonography after 1 week). Patients who had no further investigations and patients with normal ultrasonography results did not receive anticoagulation. These patients were followed for 3 months and data from this 3-month follow-up were obtained by visit or telephone contact with the patient or the general practitioner. Patients were instructed to contact their physician when symptoms of their leg worsened or when symptoms of pulmonary embolism occurred. Worsening of complaints of the leg, new complaints of the leg or respiratory tract, or an objective clinical change in the patient were followed by objective testing using ultrasonography, ventilation-perfusion scintigraphy or pulmonary angiography. The primary outcome of this study was the development of thromboembolic processes (deep venous thrombosis or pulmonary embolism) during the 3-months follow-up period. Statistics For calculation of 95% confidence intervals (CI), the exact binomial method was used. chapter 5 Figure. Diagnostic flowchart for patients with suspected deep venous thrombosis. Patients suspected of deep venous thrombosis normal D-dimer non-high clinical score normal D-dimer high clinical score abnormal D-dimer no further testing ultrasonography ultrasonography abnormal abnormal second ultrasonography abnormal 3 months follow -up 3 months follow -up 3 months follow -up 55
6 RESULTS During the study period, 902 consecutive outpatients with suspected deep venous thrombosis were referred. Of these patients, 827 (92%) were eligible and gave informed consent. There were 75 ineligible patients (Table 1). Of the 827 patients included in the study, 812 patients were fully evaluable (mean age 59 ±17 years; 518 (64%) women). None of the patients used tranexamic acid. The 15 patients that were not fully evaluable were excluded from the final analysis of the study (i.e. the 3-month thromboembolic risk): one patient (with normal serial ultrasonography) was lost to follow up, 6 patients received oral anticoagulation for reasons other than thromboembolism during follow up, 4 patients had protocol violation, and 4 patients died during follow-up. The 4 patients that died all had a positive D-dimer and normal serial ultrasonography, and the cause of death was not related to thrombosis. None of these 15 patients had venous thromboembolism at time of exclusion from the study. The main results of this study are given in Table 2. Deep venous thrombosis or pulmonary embolism was diagnosed in 317 (39%) patients during the entire study period. Deep venous thrombosis was diagnosed at initial screening in 309 patients by single or serial ultrasonography; 8 patients of the remaining 503 patients (1.6%; 95% CI: %) developed deep venous thrombosis or pulmonary embolism during the 3-months follow-up period. No deaths due to venous thromboembolism were observed during the follow-up period. In the group of patients with a non-high pretest clinical probability score and normal D-dimer concentration, deep venous thrombosis was found during follow-up in one patient (0.6; 95% CI: %). This patient returned to the hospital because of worsening of complaints 2 days after first presentation; at that time the D-dimer was abnormal and a deep calf vein thrombosis was detected by a single ultrasonogram. This patient seemed to be heterogeneous for the factor V Leiden mutation. The diagnostic strategy performed in this group had a negative predictive value of 99.4% (95% CI: %). There were no deaths in this group. The prevalence of a low or moderate clinical probability score in this group was 49% (87 of 176 patients) and 51% (89 of 176 patients), respectively. Three of the 39 patients (7.7%; 95% CI: %) with a normal D- dimer concentration and a high pretest clinical probability score had deep venous thrombosis on ultrasonography at presentation; one out of the 56
7 The AIDA study remaining 36 patients (2.8%; 95% CI: %) developed pulmonary embolism at 71 days after initial screening. At that time, the D-dimer concentration was abnormal and repeated ultrasonograms remained normal. This patient seemed to have an abdominal localized non-hodgkin lymphoma that impaired lymph drainage from the legs. The negative predictive value of this regimen was 97.2% (95% CI: %). No deaths were reported in this group. In patients with an abnormal D-dimer concentration (n=597), 291 had deep venous thrombosis detected by the first ultrasonogram, and 15 patients had it detected by the second ultrasonogram. Six of the 291 patients (2.1%; 95% CI: %) with normal serial ultrasonography developed venous thromboembolism during the 3-month follow-up period (3 deep venous thromboses and 3 pulmonary embolisms). Of these 6 patients, one was heterogeneous for the factor V Leiden mutation, one had a non-hodgkin lymphoma and one had a previous history of venous thromboembolism and was using oral anticonceptives. The diagnostic strategy in the group with serial ultrasonography had a negative predictive value of 97.9% (95% CI: %). The prevalence of a low, moderate, or high clinical score in the group with abnormal D-dimer concentrations was 19% (114 of 597 patients), 41% (243 of 597 patients), and 40% (240 of 597 patients), respectively. The prevalence of DVT in these three clinical probability groups was 22%, 51%, and 68%, respectively. If exclusion of deep venous thrombosis would have been based on a normal D-dimer concentration alone (ie, not using the pretest clinical probability score), we would have missed deep venous thrombosis in 5 of 215 patients (2.3%; 95% CI: %) with a normal D-dimer concentration; this strategy would have a negative predictive value of 97.7% (95% CI: %). The sensitivity of the D-dimer was 98.4% (95% CI: %; 312 of 317 patients), and its specificity 42.4% (95% CI: %; 210 of 495 patients). Analysis of the clinical probability score in the 812 patients showed that 24.8% (201 of 812 patients) had a low probability score, 40.9% (332 of 812 patients) a moderate and 34.3% (279 of 812 patients) a high probability score. The prevalence of deep venous thrombosis in the three probability categories was 12.9%, 37.7%, and 59.5%, respectively. The sensitivity of the D-dimer in patients with a low probability score was 96.2%, the negative predictive value was 98.9%, and specificity was 51.4%. In patients with a moderate score, the values were 100%, 100% and 39.6%, respec- chapter 5 57
8 tively. In patients with a high probability score, the D-dimer had values of 97.6%, 90.5% and 33.6%, respectively. The total number of ultrasonograms performed in this study was 949; if a strategy of serial ultrasonography was performed in all patients in this study, we would have performed 1335 ultrasonograms. Our diagnostic strategy led to a reduction of 29% in the need for ultrasonograms. 58
9 The AIDA study Table 1. Reasons for exclusion in 75 patients. Reason for exclusion N Pregnancy 1 Previous deep venous thrombosis in the ipsilateral leg without 6 documentation of recanalization Concomitant clinical suspicion of pulmonary embolism 3 The use of unfractionated heparin, low-molecular-weight heparin 50 or any form of oral anticoagulant in the past month Geographic impossibility for follow-up 3 Life expectancy < 3 months 1 No informed consent obtained 11 (8 refused and 3 were mentally incapable of signing). Table 2. Prevalence of venous thromboembolism according to D-dimer result and pretest clinical probability score. Values are reported as number (percentage;95% confidence intervals). chapter 5 Group VTE during follow up, Overall VTE, n (%) n (%; 95% CI) n (%; 95% CI) Normal D-dimer 176 (22%) 1 (0.6%; ) 1 (0.6%; ) and non-high score Normal D-dimer 39 (5%) 1 (2.8%; ) 4 (10.3%; ) and high score Normal D-dimer 215 (26%) 2 (0.9%; %) 5 (2.3%; %) Abnormal D-dimer 597 (74%) 6 (2.1%; ) 312 (52.3%; ) Total 812 (100%) 8 (1.6%; ) 317 (39.0%; ) VTE indicates venous thromboembolism and includes deep venous thrombosis and pulmonary embolism 59
10 DISCUSSION This study indicates that it is relatively safe to withhold anticoagulation in outpatients suspected of having deep venous thrombosis who have a normal D-dimer test and a non-high pretest clinical probability score. This approach will reduce the need for compression ultrasonography. The role of the pretest clinical probability score and/or the D-dimer concentration in the diagnostic management of deep venous thrombosis has been the objective of many different studies (4-14;16;17). All suggested diagnostic regimens may not exceed the failure rate (percentage of missed deep venous thrombosis) of 0.6% and 0.7% that have been reported in 2 landmark studies on the safety of serial ultrasonography (1;2). The failure rate of 0.6% (CI %) in our study for patients with a non-high pretest clinical probability score and a normal D-dimer concentration is comparable with the studies in which serial ultrasonography has been used. Therefore, we conclude that this regimen can replace serial ultrasonography in this subgroup of patients with suspected deep venous thrombosis. A part of the follow-up in our patients was provided by their general practitioner. In The Netherlands, patients see their general practitioner on a regular basis and the general practitioner provides follow-up of their patients in many diseases. In case of hospitalization, the general practitioner will always be notified. At 3 months, patients were seen by a physician in one of the participating institutes or by their general practitioner or they were contacted by telephone by a physician in one of the participating institutes. If a telephone contact revealed continues complaints of the leg, patients were seen by their general practitioner or a physician. A likewise method of follow-up has also been used in other management studies on the diagnosis of venous thromboembolism (5;18). The prevalence of deep venous thrombosis in our study population was relatively high (39%), especially compared with other recent studies (1;2;5-7;14;16;17). In our institutes, this prevalence has been that high for several years. Since the participating centers in this study are the only institutes for diagnosing thrombosis in the region and because we have used consecutive patients, we do not believe that this high prevalence is due to some kind of bias. A possible explanation for this prevalence might be the referral pattern of the general practitioner. Despite this high prevalence, exclusion of deep venous thrombosis without performing an ultrasonography was possible in 22% of the patients. The need for ultrasonography in the whole study pop- 60
11 The AIDA study ulation was reduced by approximately 30%, which means an economical advantage and less inconvenience for patients and radiology staffs. Our results also open the possibility for general practitioners to rule out deep venous thrombosis in a substantial number of patients without presenting those patients to the emergence wards. Where previous reports excluded deep venous thrombosis using the combination of a normal D-dimer concentration and only a low pretest clinical probability score (16;17), we show that deep venous thrombosis can also be excluded in patients with a normal D-dimer concentration and a low and moderate pretest clinical probability score. However, a D-dimer assay with a high sensitivity is an important prerequisite in our strategy. Because the sensitivity of the D-dimer assay in previous reports (using the SimpliRed D- dimer assay) was only 85%, one needs to rely more extensively on the pretest clinical probability score for a safe exclusion of deep venous thrombosis. However, due to the probability of an alternative diagnosis, this score is highly subjective and shows large interobserver variability (19). The D- dimer in our study had a sensitivity of 98.4% and a negative predictive value of 97.7%. For exclusion of deep venous thrombosis in patients with a non-high pretest clinical probability score and a normal D-dimer concentration, we recommend the use of a D-dimer assay with at least a sensitivity and negative predictive value as high as the one used in the present study. Leaving out the pretest clinical probability score from our strategy, would have led to an increase in the percentage of missed venous thromboembolism from 0.6% (95% CI: %) to 2.3% (95% CI: %) in patients with a normal D-dimer concentration. Because of the small number of missed thromboembolic processes, however, the confidence intervals overlap. However, this possible additional value of a simple pretest clinical probability score was achieved despite the fact that it was performed by more than 20 junior residents in 4 different hospitals. Therefore, we recommend using the combination of the pretest clinical probability score and a D-dimer test in stead of using the D-dimer alone to exclude deep venous thrombosis, as suggested by some authors (11). The use of the pretest clinical probability score had only a limited effect on the total number of patients in whom serial ultrasonography can be avoided: 39 of the 215 patients (18.1%) with a normal D-dimer concentration underwent a single ultrasonogram because of a high pretest clinical probability. The overall failure rate of the diagnostic strategy in our study was 1.6% (95% CI: %). In the patients in our study in whom serial ultrasonog- chapter 5 61
12 raphy was performed, the failure rate was 2.1% (95% CI: %). This higher percentage can be explained by the fact that only patients with a positive D-dimer assay and, therefore, a higher a priori chance of having deep venous thrombosis underwent serial ultrasonography. In conclusion, the combination of a non-high pretest clinical probability score and a normal D-dimer concentration is a safe strategy to rule out deep venous thrombosis without performing ultrasonography in symptomatic outpatients. The need for ultrasonography can be reduced by approximately 30% using this strategy. 62
13 The AIDA study REFERENCE LIST 1. Birdwell BG, Raskob GE, Whitsett TL et al. The clinical validity of normal compression ultrasonography in outpatients suspected of having deep venous thrombosis. Ann Intern Med 1998;128: Cogo A, Lensing AW, Koopman MM et al. Compression ultrasonography for diagnostic management of patients with clinically suspected deep vein thrombosis: prospective cohort study. BMJ 1998;316: Bernardi E, Prandoni P, Lensing AW et al. D-dimer testing as an adjunct to ultrasonography in patients with clinically suspected deep vein thrombosis: prospective cohort study. The Multicentre Italian D-dimer Ultrasound Study Investigators Group. BMJ 1998;317: Bounameaux H, de Moerloose P, Perrier A et al. D-dimer testing in suspected venous thromboembolism: an update. QJM 1997;90: Wells PS, Hirsh J, Anderson DR et al. Accuracy of clinical assessment of deep-vein thrombosis. Lancet 1995;345: Wells PS, Anderson DR, Bormanis J et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet 1997;350: Perrier A, Bounameaux H. Cost-effective diagnosis of deep vein thrombosis and pulmonary embolism. Thromb Haemost 2001;86: Bounameaux H, de Moerloose P, Perrier A et al. Plasma measurement of D-dimer as diagnostic aid in suspected venous thromboembolism: an overview. Thromb Haemost 1994;71: Bates SM, Grand Maison A, Johnston M et al. A latex D-dimer reliably excludes venous thromboembolism. Arch Intern Med 2001;161: Janssen MC, Heebels AE, de Metz M et al. Reliability of five rapid D-dimer assays compared to ELISA in the exclusion of deep venous thrombosis. Thromb Haemost 1997;77: Perrier A, Desmarais S, Miron MJ et al. Non-invasive diagnosis of venous thromboembolism in outpatients. Lancet 1999;353: Van der Graaf F, van den Borne H, van der Kolk M et al. Exclusion of deep venous thrombosis with D-dimer testing comparison of 13 D-dimer methods in 99 outpatients suspected of deep venous thrombosis using venography as reference standard. Thromb Haemost 2000;83: Wahlander K, Tengborn L, Hellstrom M et al. Comparison of various D-dimer tests for the diagnosis of deep venous thrombosis. Blood Coagul Fibrinolysis 1999;10: chapter 5 63
14 14. Kraaijenhagen R.A, Piovella F, Bernardi E et al. Simplification of the diagnostic management of suspected deep vein thrombosis. Arch Intern Med 2002;162: Lindahl TL, Lundahl TH, Fransson SG. Evaluation of an automated micro-latex D-dimer assay (Tina-quant on Hitachi 911 analyser) in symptomatic outpatients with suspected DVT. Thromb Haemost 1999;82: Janes S, Ashford N. Use of a simplified clinical scoring system and D-dimer testing can reduce the requirement for radiology in the exclusion of deep vein thrombosis by over 20%. Br J Haematol 2001;112 : Kearon C, Ginsberg JS, Douketis J et al. Management of suspected deep venous thrombosis in outpatients by using clinical assessment and D-dimer testing. Ann Intern Med 2001;135: Wells PS, Anderson DR, Rodger M. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and D-dimer. Ann Intern Med 2001;135: Bigaroni A, Perrier A, Bounameaux H. Is clinical probability assessment of deep vein thrombosis by a score really standardized? Thromb Haemost 2000;83:788-9 (Erratum Thromb Haemost 2001;85:576). 64
Deep Vein Thrombosis: Can a Second Sonographic Examination Be Avoided?
Alfonsa Friera 1 Nuria R. Giménez 2 Paloma Caballero 1 Pilar S. Moliní 2 Carmen Suárez 2 Received August 15, 2001; accepted after revision October 16, 2001. 1 Radiology Department, Hospital de la Princesa,
More informationNo influence of heparin plasma and other (pre)analytic variables on D-dimer determination
CHAPTER 2 No influence of heparin plasma and other (pre)analytic variables on D-dimer determination R.E.G. Schutgens 1, F.J.L.M. Haas 2, H.J.T. Ruven 2, M. Spannagl 3, K. Horn 3, D.H. Biesma 1 Departments
More informationsuspected deep-vein thrombosis is a common condition, with a lifetime cumulative incidence of 2 to 5 percent. Untreated deep-vein thrombosis can resul
original article Evaluation of d-dimer in the Diagnosis of Suspected Deep-Vein Thrombosis Philip S. Wells, M.D., David R. Anderson, M.D., Marc Rodger, M.D., Melissa Forgie, M.D., Clive Kearon, M.D., Ph.D.,
More informationThe diagnosis and prognosis of venous thromboembolism : variations on a theme Gibson, N.S.
UvA-DARE (Digital Academic Repository) The diagnosis and prognosis of venous thromboembolism : variations on a theme Gibson, N.S. Link to publication Citation for published version (APA): Gibson, N. S.
More informationED Diagnosis of DVT or tools to rule out DVT in your ED
ED Diagnosis of DVT or tools to rule out DVT in your ED Ralph Wang UCSF Department of Emergency Medicine 53 yo f c/o left leg swelling recent cholecystectomy its midnight how do you manage this patient?
More informationMost primary care patients with suspected
Excluding deep vein thrombosis safely in primary care Validation study of a simple diagnostic rule D. B. Toll, MSc, R. Oudega, MD, PhD, R. J. Bulten, MD, A.W. Hoes, MD, PhD, K. G. M. Moons, PhD Julius
More informationCover Page. The handle holds various files of this Leiden University dissertation.
Cover Page The handle http://hdl.handle.net/1887/21764 holds various files of this Leiden University dissertation. Author: Mos, Inge Christina Maria Title: A more granular view on pulmonary embolism Issue
More informationFrom the Departments of Medicine, University of Ottawa, Ottawa, Canada, McMaster University, Hamilton, Canada, Dalhousie University, Halifax, Canada
2000 Schattauer Verlag, Stuttgart Derivation of a Simple Clinical Model to Categorize Patients Probability of Pulmonary Embolism: Increasing the Models Utility with the SimpliRED D-dimer Philip S. Wells,
More informationORIGINAL INVESTIGATION
ORIGINAL INVESTIGATION Clinical Usefulness of D-Dimer Depending on Clinical Probability and Cutoff Value in Outpatients With Suspected Pulmonary Embolism Marc Righini, MD; Drahomir Aujesky, MD; Pierre-Marie
More informationRecognition of or ruling out deep venous thrombosis
Article The Wells Rule Does Not Adequately Rule Out Deep Venous Thrombosis in Primary Care Patients Ruud Oudega, MD; Arno W. Hoes, MD, PhD; and Karel G.M. Moons, PhD Background: Using data from secondary
More informationORIGINAL INVESTIGATION
ORIGINAL INVESTIGATION A Latex D-Dimer Reliably Excludes Venous Thromboembolism Shannon M. Bates, MD, CM; Anne Grand Maison, MD; Marilyn Johnston, ART; Ivy Naguit, MLT; Michael J. Kovacs, MD; Jeffrey S.
More informationORIGINAL INVESTIGATION
Use of a Clinical Decision Rule in Combination With D-Dimer Concentration in Diagnostic Workup of Patients With Suspected Pulmonary Embolism A Prospective Management Study ORIGINAL INVESTIGATION Marieke
More informationChapter 3. Simplification of the revised Geneva score for assessing clinical probability of pulmonary embolism
Chapter 3 Simplification of the revised Geneva score for assessing clinical probability of pulmonary embolism F.A. Klok, I.C.M. Mos, M. Nijkeuter, M. Righini, A. Perrier, G. Le Gal and M.V. Huisman Arch
More informationUltrasonography and Diagnosis of Venous Thromboembolism
Ultrasonography and Diagnosis of Venous Thromboembolism Brenda K. Zierler, PhD Abstract Venous thromboembolism (VTE) consists of two related conditions: pulmonary embolism (PE) and deep vein thrombosis
More informationCitation for published version (APA): Douma, R. A. (2010). Pulmonary embolism: advances in diagnosis and prognosis
UvA-DARE (Digital Academic Repository) Pulmonary embolism: advances in diagnosis and prognosis Douma, R.A. Link to publication Citation for published version (APA): Douma, R. A. (2010). Pulmonary embolism:
More informationThe usefulness of five D-dimer assays in the exclusion of deep venous thrombosis
Journal of Thrombosis and Haemostasis, 1: 976 981 ORIGINAL ARTICLE The usefulness of five D-dimer assays in the exclusion of deep venous thrombosis R. E. G. SCHUTGENS, F. J. L. M. HAAS,y W. B. M. GERRITSEN,y
More informationDiagnostic Algorithms in VTE
Diagnostic Algorithms in VTE Mark H. Meissner, MD Department of Surgery University of Washington School of Medicine Overutilization of Venous Duplex U/S 1983-1993 (Zweibel et al, Australasian Rad, 1995)
More informationClinical relevance of distal deep vein thrombosis Marc Righini and Henri Bounameaux
Clinical relevance of distal deep vein thrombosis Marc Righini and Henri Bounameaux Division of Angiology and Hemostasis, Geneva University Hospital, Geneva, Switzerland Correspondence to Marc Righini,
More informationCover Page. The handle holds various files of this Leiden University dissertation
Cover Page The handle http://hdl.handle.net/1887/40114 holds various files of this Leiden University dissertation Author: Exter, Paul L. den Title: Diagnosis, management and prognosis of symptomatic and
More informationDeep venous thrombosis is a common condition that. Article
Article Negative D-Dimer Result To Exclude Recurrent Deep Venous Thrombosis: A Management Trial Suman W. Rathbun, MD, MS; Thomas L. Whitsett, MD; and Gary E. Raskob, PhD Background: All of the available
More informationORIGINAL INVESTIGATION. predictive value for compression ultrasonography. for Deep Vein Thrombosis in Symptomatic Outpatients
ORIGINAL INVESTIGATION Predictive Value of Compression Ultrasonography for Deep Vein Thrombosis in Symptomatic Outpatients Clinical Implications of the Site of Vein Noncompressibility Brian G. Birdwell,
More informationThe Role of D-Dimer in the Diagnosis of Venous Thromboembolism
science [chemistry coagulation and hematology] The Role of D-Dimer in the Diagnosis of Venous Thromboembolism Donald H. Schreiber MD, CM FRCPC FACEP Division of Emergency Medicine, Stanford University
More informationSimplified approach to investigation of suspected VTE
Simplified approach to investigation of suspected VTE Diagnosis of DVT and PE THSNA 2016, Chicago 15 April 2016 Clive Kearon, McMaster University, Canada Relevant Disclosures Research Support/P.I. Employee
More informationEvolution of untreated calf deep-vein thrombosis in high risk symptomatic outpatients: The blind, prospective CALTHRO study
New Technologies, Diagnostic Tools and Drugs Schattauer 2010 1 Evolution of untreated calf deep-vein thrombosis in high risk symptomatic outpatients: The blind, prospective CALTHRO study Gualtiero Palareti
More informationClinical experience and pre-test probability scores in the diagnosis of pulmonary embolism
Q J Med 2003; 96:211 215 doi:10.1093/qjmed/hcg027 Clinical experience and pre-test probability scores in the diagnosis of pulmonary embolism S. ILES, A.M. HODGES, J.R. DARLEY, C. FRAMPTON 1,M.EPTON,L.E.L.BECKERT
More informationCitation for published version (APA): Douma, R. A. (2010). Pulmonary embolism: advances in diagnosis and prognosis
UvA-DARE (Digital Academic Repository) Pulmonary embolism: advances in diagnosis and prognosis Douma, R.A. Link to publication Citation for published version (APA): Douma, R. A. (2010). Pulmonary embolism:
More informationImplementing a Diagnostic Algorithm for Deep Venous Thrombosis
Implementing a Diagnostic Algorithm for Deep Venous Thrombosis Abstract Context: An alternative to compression ultrasonography (CUS) examination of the lower extremity to diagnose deep venous thrombosis
More informationDVT Diagnosis. Reference methods. Whole leg Ultrasonography. Predictive values. Page 1. Diagnosis of 1 st time symptomatic DVT.
DVT Diagnosis Ulf Nyman Associate Professor Lund University Department of Radiology East Division (Kristianstad, HässleholmH Trelleborg, Ystad) Sweden Diagnosis of 1 st time symptomatic DVT Scientific
More informationShould we diagnose and treat distal deep vein thrombosis?
CONTROVERSIES IN VENOUS THROMBOEMBOLISM: TO TREAT OR NOT TO TREAT Should we diagnose and treat distal deep vein thrombosis? Helia Robert-Ebadi and Marc Righini Division of Angiology and Hemostasis, Geneva
More informationClinical Guide - Suspected PE (Reviewed 2006)
Clinical Guide - Suspected (Reviewed 2006) Principal Developer: B. Geerts Secondary Developers: C. Demers, C. Kearon Background Investigation of patients with suspected pulmonary emboli () remains problematic
More informationD-dimer Value more than 3.6 μg/ml is Highly Possible Existence Deep Vein Thrombosis
Original Contribution This is Advance Publication Article Kurume Medical Journal, 60, 00-00, 2013 D-dimer Value more than 3.6 μg/ml is Highly Possible Existence Deep Vein Thrombosis SHINICHI NATA, SHINICHI
More informationCURRENT & FUTURE THERAPEUTIC MANAGEMENT OF VENOUS THROMBOEMBOLISM. Gordon Lowe Professor of Vascular Medicine University of Glasgow
CURRENT & FUTURE THERAPEUTIC MANAGEMENT OF VENOUS THROMBOEMBOLISM Gordon Lowe Professor of Vascular Medicine University of Glasgow VENOUS THROMBOEMBOLISM Common cause of death and disability 50% hospital-acquired
More informationComparing the Diagnostic Performance of 2 Clinical Decision Rules to Rule Out Deep Vein Thrombosis in Primary Care Patients
Comparing the Diagnostic Performance of 2 Clinical Decision Rules to Rule Out Deep Vein Thrombosis in Primary Care Patients Eit Frits van der Velde, MD 1 Diane B. Toll, PhD 2 Arina J. ten Cate-Hoek, MD
More informationImportance of Pretest Probability Score and D-Dimer Assay Before Sonography for Lower Limb Deep Venous Thrombosis
Subramania m et al. Sonography of Lower Limb Deep Venous Thrombosis Vascular Imaging Original Research A C M E D E N T U R I C A L I M A G I N G AJR 2006; 186:206 212 0361 803X/06/1861 206 American Roentgen
More informationUsefulness of D-dimer, blood gas, and respiratory rate measurements for excluding pulmonary embolism
830 Canterbury Respiratory Research Group, Christchurch School of Medicine, PO Box 4345, Christchurch, New Zealand P Egermayer GITown A L Mee Canterbury Health Ltd, New Zealand J G Turner D C Heaton M
More informationACR Appropriateness Criteria Suspected Lower Extremity Deep Vein Thrombosis EVIDENCE TABLE
. Fowkes FJ, Price JF, Fowkes FG. Incidence of diagnosed deep vein thrombosis in the general population: systematic review. Eur J Vasc Endovasc Surg 003; 5():-5.. Hamper UM, DeJong MR, Scoutt LM. Ultrasound
More informationIs thromboprophylaxis effective in reducing the pulmonary thromboembolism?
Is thromboprophylaxis effective in reducing the pulmonary thromboembolism? Fereshteh Rajabi (1), Masoumeh Sadeghi (2), Fereshteh Karbasian (3), Ali Torkan (4) Abstract BACKGROUND: Deep vein thrombosis
More informationClinically Suspected Acute Recurrent Pulmonary Embolism: A Diagnostic Challenge
7 Clinically Suspected Acute Recurrent Pulmonary Embolism: A Diagnostic Challenge M. Nijkeuter, H. Kwakkel- van Erp, M. Sohne, L.W. Tick, M.J.H.A. Kruip, E.F. Ullmann, M.H.H Kramer, H.R. Büller, M.H. Prins,
More informationCombination of a clinical risk assessment score and rapid whole blood D-dimer testing in the diagnosis of deep vein thrombosis in symptomatic patients
Combination of a clinical risk assessment score and rapid whole blood D-dimer testing in the diagnosis of deep vein thrombosis in symptomatic patients Andrew F. Lennox, MSc, FRACS, Konstantinos T. Delis,
More informationProper Diagnosis of Venous Thromboembolism (VTE)
Proper Diagnosis of Venous Thromboembolism (VTE) Whal Lee, M.D. Seoul National University Hospital Department of Radiology 2 nd EFORT Asia Symposium, 3 rd November 2010, Taipei DVT - Risk Factors Previous
More informationSupplementary Online Content
Supplementary Online Content Mismetti P, Laporte S, Pellerin O, Ennezat P-V, Couturaud F, Elias A, et al. Effect of a retrievable inferior vena cava filter plus anticoagulation vs anticoagulation alone
More informationCitation for published version (APA): Mac Gillavry, M. R. (2001). Some understanding of diagnostic tests for pulmonary embolism
UvA-DARE (Digital Academic Repository) Some understanding of diagnostic tests for pulmonary embolism Mac Gillavry, M.R. Link to publication Citation for published version (APA): Mac Gillavry, M. R. (2001).
More informationCover Page. The handle holds various files of this Leiden University dissertation
Cover Page The handle http://hdl.handle.net/1887/33063 holds various files of this Leiden University dissertation Author: Tan, Melanie Title: Clinical aspects of recurrent venous thromboembolism Issue
More informationDiagnosis and Treatment of Deep Venous Thrombosis and Pulmonary Embolism
Agency for Healthcare Research and Quality Evidence Report/Technology Assessment Diagnosis and Treatment of Deep Venous Thrombosis and Pulmonary Embolism Summary Number 68 Overview Venous thromboembolism
More informationObserved Differences in Diagnostic Test Accuracy between Patient Subgroups: Is It Real or Due to Reference Standard Misclassification?
Clinical Chemistry 53:10 1725 1729 (2007) Overview Observed Differences in Diagnostic Test Accuracy between Patient Subgroups: Is It Real or Due to Reference Standard Misclassification? Corné Biesheuvel,
More informationHow we diagnose and treat deep vein thrombosis
How I treat How we diagnose and treat deep vein thrombosis Jack Hirsh and Agnes Y. Y. Lee Making a diagnosis of deep vein thrombosis (DVT) requires both clinical assessment and objective testing because
More informationCitation for published version (APA): Douma, R. A. (2010). Pulmonary embolism: advances in diagnosis and prognosis
UvA-DARE (Digital Academic Repository) Pulmonary embolism: advances in diagnosis and prognosis Douma, R.A. Link to publication Citation for published version (APA): Douma, R. A. (2010). Pulmonary embolism:
More informationChapter 1. Introduction
Chapter 1 Introduction Introduction 9 Even though the first reports on venous thromboembolism date back to the 13 th century and the mechanism of acute pulmonary embolism (PE) was unraveled almost 150
More informationCitation for published version (APA): Mac Gillavry, M. R. (2001). Some understanding of diagnostic tests for pulmonary embolism
UvA-DARE (Digital Academic Repository) Some understanding of diagnostic tests for pulmonary embolism Mac Gillavry, M.R. Link to publication Citation for published version (APA): Mac Gillavry, M. R. (2001).
More informationCover Page. The handle holds various files of this Leiden University dissertation
Cover Page The handle http://hdl.handle.net/1887/40114 holds various files of this Leiden University dissertation Author: Exter, Paul L. den Title: Diagnosis, management and prognosis of symptomatic and
More informationAntithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
CHEST Supplement ANTITHROMBOTIC THERAPY AND PREVENTION OF THROMBOSIS, 9TH ED: ACCP GUIDELINES Diagnosis of Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians
More informationAge-adjusted vs conventional D-dimer thresholds in the diagnosis of venous thromboembolism
James Madison University JMU Scholarly Commons Physician Assistant Capstones The Graduate School 5-16-2017 Age-adjusted vs conventional D-dimer thresholds in the diagnosis of venous thromboembolism Kirsten
More informationHow to Diagnose Pulmonary Embolism anno 2014?
How to Diagnose Pulmonary Embolism anno 2014? Mark H.H. Kramer, MD, PhD, FRCP FACP Professor of Medicine VU University Medical Center Amsterdam, The Netherlands What are we going to discuss? Age adjusted
More informationComparison between Critical Pathway Guidelines and Management of Deep-Vein Thrombosis: Retrospective Cohort Study
41(2):163-167,2000 CLINICAL SCIENCES Comparison between Critical Pathway Guidelines and Management of Deep-Vein Thrombosis: Retrospective Cohort Study Nikša Vuèiæ, Nada Lang, Stjepan Baliæ, Vladimir Pilaš,
More informationRecommendations. Recommendation 2. American College of Physicians, Philadelphia, Penn. Merck Institute of Aging and Health, Gloucester Point, Va
Current Diagnosis of Venous Thromboembolism in Primary Care: A Clinical Practice Guideline from the American Academy of Family Physicians and the American College of Physicians Amir Qaseem, MD, PhD, MHA
More informationPulmonary Embolism. Pulmonary Embolism. Pulmonary Embolism. PE - Clinical
Pulmonary embolus - a practical approach to investigation and treatment Sam Janes Wellcome Senior Fellow and Respiratory Physician, University College London Background Diagnosis Treatment Common: 50 cases
More informationRecurrence risk after anticoagulant treatment of limited duration for late, second venous thromboembolism
ARTICLES Coagulation & its Disorders Recurrence risk after anticoagulant treatment of limited duration for late, second venous thromboembolism Tom van der Hulle, Melanie Tan, Paul L. den Exter, Mark J.G.
More informationCHAPTER 2 VENOUS THROMBOEMBOLISM
CHAPTER 2 VENOUS THROMBOEMBOLISM Objectives Venous Thromboembolism (VTE) Prevalence Patho-physiology Risk Factors Diagnosis Pulmonary Embolism (PE) Management of DVT/PE Prevention VTE Patho-physiology
More informationComparison of a Clinical Probability Estimate and Two Clinical Models in Patients with Suspected Pulmonary Embolism
2000 Schattauer Verlag, Stuttgart Thromb Haemost 2000; 83: 199 203 Comparison of a Clinical Probability Estimate and Two Clinical Models in Patients with Suspected Pulmonary Embolism Bernd-Jan Sanson 1,
More informationSAFETY OF A PULMONARY EMBOLISM AMBULATORY TREATMENT PROGRAM
SAFETY OF A PULMONARY EMBOLISM AMBULATORY TREATMENT PROGRAM Mahir M. Hamad 1, MD, FRCP, Elrasheed A. Ellidir 1, MD, MRCP, Charlotte Routh 1, MD, MRCP, Siraj O. Wali 2, FACP, FCCP, and Vincent M. Connolly
More informationORIGINAL INVESTIGATION. The Impact of the Introduction of a Rapid D-Dimer Assay on the Diagnostic Evaluation of Suspected Pulmonary Embolism
ORIGINAL INVESTIGATION The Impact of the Introduction of a Rapid D-Dimer Assay on the Diagnostic Evaluation of Suspected Pulmonary Embolism Nir M. Goldstein, MD; Marin H. Kollef, MD; Suzanne Ward, RN;
More informationIndian Journal of Basic and Applied Medical Research; June 2012: Vol.-1, Issue-3, P
Original article: Efficacy of Different Treatment Protocols of Low Molecular Weight Heparin for Prevention of Deep Vein Thrombosis in Patients Undergoing Orthopaedic Surgery: A Comparative Study Dr. Kamlesh
More informationD-dimer Testing for Suspected Pulmonary Embolism in Outpatients
D-dimer Testing for Suspected Pulmonary Embolism in Outpatients ARNAUD PERRIER, SYLVIE DESMARAIS, CATHERINE GOEHRING, PHILIPPE de MOERLOOSE, ALFREDO MORABIA, PIERRE-FRANÇOIS UNGER, DANIEL SLOSMAN, ALAIN
More informationCover Page. The handle holds various files of this Leiden University dissertation.
Cover Page The handle http://hdl.handle.net/1887/19768 holds various files of this Leiden University dissertation. Author: Langevelde, Kirsten van Title: Are pulmonary embolism and deep-vein thrombosis
More informationDeep vein thrombosis and its prevention in critically ill adults Attia J, Ray J G, Cook D J, Douketis J, Ginsberg J S, Geerts W H
Deep vein thrombosis and its prevention in critically ill adults Attia J, Ray J G, Cook D J, Douketis J, Ginsberg J S, Geerts W H Authors' objectives To systematically review the incidence of deep vein
More informationDiagnosis of Deep Venous Thrombosis and Pulmonary Embolism
Diagnosis of Deep Venous Thrombosis and Pulmonary Embolism JASON WILBUR, MD, and BRIAN SHIAN, MD, Carver College of Medicine, University of Iowa, Iowa City, Iowa Venous thromboembolism manifests as deep
More informationBedside Emergency Ultrasound For Deep Venous Thrombosis
Bedside Emergency Ultrasound For Deep Venous Thrombosis Michael Blaivas, MD, MBA(candidate) FACEP, FAIUM Professor of Medicine University of South Carolina School of Medicine AIUM Third Vice President
More informationThe Modified Wells Score Accurately Excludes Pulmonary Embolus in Hospitalized Patients Receiving Heparin Prophylaxis
ORIGINAL RESEARCH The Modified Wells Score Accurately Excludes Pulmonary Embolus in Hospitalized Patients Receiving Heparin Prophylaxis Amit Bahia, MD 1,2 Richard K. Albert, MD 1,2 1 Department of Medicine,
More informationIsolated Deep Venous Thrombosis: Implications for 2-Point Compression Ultrasonography of the Lower Extremity
IMAGING/ORIGINAL RESEARCH Isolated Deep Venous Thrombosis: Implications for 2-Point Compression Ultrasonography of the Lower Extremity Srikar Adhikari, MD, MS*; Wes Zeger, DO; Christopher Thom, MD; J.
More informationCover Page. The handle holds various files of this Leiden University dissertation.
Cover Page The handle http://hdl.handle.net/1887/19768 holds various files of this Leiden University dissertation. Author: Langevelde, Kirsten van Title: Are pulmonary embolism and deep-vein thrombosis
More informationDOPPLER ULTRASOUND OF DEEP VENOUS THROMBOSIS
TOKUDA HOSPITAL SOFIA DOPPLER ULTRASOUND OF DEEP VENOUS THROMBOSIS MILENA STANEVA, MD, PhD Department of vascular surgery and angiology Venous thromboembolic disease continues to cause significant morbidity
More informationCitation for published version (APA): Mac Gillavry, M. R. (2001). Some understanding of diagnostic tests for pulmonary embolism
UvA-DARE (Digital Academic Repository) Some understanding of diagnostic tests for pulmonary embolism Mac Gillavry, M.R. Link to publication Citation for published version (APA): Mac Gillavry, M. R. (2001).
More informationVenous thrombosis is common and often occurs spontaneously, but it also frequently accompanies medical and surgical conditions, both in the community
Venous Thrombosis Venous Thrombosis It occurs mainly in the deep veins of the leg (deep vein thrombosis, DVT), from which parts of the clot frequently embolize to the lungs (pulmonary embolism, PE). Fewer
More informationCover Page. The handle holds various files of this Leiden University dissertation
Cover Page The handle http://hdl.handle.net/1887/40114 holds various files of this Leiden University dissertation Author: Exter, Paul L. den Title: Diagnosis, management and prognosis of symptomatic and
More informationCover Page. The handle holds various files of this Leiden University dissertation.
Cover Page The handle http://hdl.handle.net/188/20915 holds various files of this Leiden University dissertation. Author: Flinterman, Linda Elisabeth Title: Risk factors for a first and recurrent venous
More informationSaiseikai Fukuoka General Hospital, Fukuoka, Japan
Original Research Hellenic J Cardiol 211; 52: 123-127 D-Dimer Is Helpful for Differentiating Acute Aortic Dissection and Acute Pulmonary Embolism from Acute Myocardial Infarction Kazuo Sakamoto, Yusuke
More informationPOINT OF CARE ULTRASOUND - Venous US for DVT
POINT OF CARE ULTRASOUND - Venous US for DVT The diagnosis of deep venous thrombosis (DVT) using ultrasound in the emergency department. DVT US is easy to perform and can be usually be completed in less
More informationRESEARCH. Excluding venous thromboembolism using point of care D-dimer tests in outpatients: a diagnostic meta-analysis
Excluding venous thromboembolism using point of care D-dimer tests in outpatients: a diagnostic meta-analysis G J Geersing, general practitioner, 1 K J M Janssen, clinical epidemiologist, 1 R Oudega, general
More informationC-reactive protein and D-dimer with clinical probability score in the exclusion of pulmonary embolism
research paper C-reactive protein and D-dimer with clinical probability score in the exclusion of pulmonary embolism N. Steeghs, 1 R. J. Goekoop, 1 R. W. L. M. Niessen, 2 G. J. P. M. Jonkers, 3 H. Dik
More informationUniversity of Groningen
University of Groningen Potential of an age adjusted D-dimer cut-off value to improve the exclusion of pulmonary embolism in older patients: A retrospective analysis of three large cohorts Douma, Renée
More informationPatients with suspected DVT of the lower limb how to exam the patient
Patients with suspected DVT of the lower limb how to exam the patient Johannes Godt Dep. of Radiology and Nuclear Medicine Oslo University Hospital Ullevål NORDTER 2015, Oslo Content Anatomy and pathophysiology
More informationProspective Validation of Wells Criteria in the Evaluation of Patients With Suspected Pulmonary Embolism
PULMONARY/ORIGINAL RESEARCH Prospective Validation of Wells Criteria in the Evaluation of Patients With Suspected Pulmonary Embolism Stephen J. Wolf, MD Tracy R. McCubbin, MD Kim M. Feldhaus, MD Jeffrey
More informationBEDSIDE ULTRASOUND BEDSIDE ULTRASOUND. Deep Vein Thrombosis. Probe used
BEDSIDE ULTRASOUND Part 2 Diagnosis of deep vein thrombosis Kishore Kumar Pichamuthu, Professor, Department of Critical Care, CMC, Vellore Summary: Deep vein thrombosis (DVT) is a problem encountered in
More informationCover Page. The handle holds various files of this Leiden University dissertation
Cover Page The handle http://hdl.handle.net/1887/40114 holds various files of this Leiden University dissertation Author: Exter, Paul L. den Title: Diagnosis, management and prognosis of symptomatic and
More informationD-Dimer in Patients With Clinically Suspected Pulmonary Embolism*
D-Dimer in Patients With Clinically Suspected Pulmonary Embolism* JeffreyS. Ginsberg, M.D. F.C.C.P.; Patrick A. Brill-Edwards, M.D., F.C.C.P. ; Christine Demers, M.D.; Dianne Donovan, R.N.; and Akbar Panju,
More informationORIGINAL INVESTIGATION. The Bedside Investigation of Pulmonary Embolism Diagnosis Study
ORIGINAL INVESTIGATION The Bedside Investigation of Pulmonary Embolism Diagnosis Study A Double-blind Randomized Controlled Trial Comparing Combinations of 3 Bedside Tests vs Ventilation-Perfusion Scan
More informationPost-Thrombotic Syndrome Prevention and Management. Dr. Ashwini Bennett
Post-Thrombotic Syndrome Prevention and Management Dr. Ashwini Bennett Disclosures No disclosures relevant to this presentation Outline Importance of VTE and PTS Aetiology of PTS PTS risk factors PTS clinical
More informationTools for the Clinician: The Essentials of Bedside (ED or ICU) Ultrasound for Deep Vein Thrombosis
Curr Emerg Hosp Med Rep (2013) 1:65 70 DOI 10.1007/s40138-013-0016-4 THROMBOSIS (D SLATTERY, SECTION EDITOR) Tools for the Clinician: The Essentials of Bedside (ED or ICU) Ultrasound for Deep Vein Thrombosis
More information8,9,10. Deep venous thrombosis (DVT) is clotting of blood in a deep vein of Pulmonary embolism
CANCER ASSOCIATED THROMBOSIS DIAGNOSIS OF VTE In patients with cancer-associated thrombosis, landmark studies have demonstrated that effective prophylaxis and treatment of thrombosis reduces morbidity
More informationDisclosures. DVT: Diagnosis and Treatment. Questions To Ask. Dr. Susanna Shin - DVT: Diagnosis and Treatment. Acute Venous Thromboembolism (VTE) None
Disclosures DVT: Diagnosis and Treatment None Susanna Shin, MD, FACS Assistant Professor University of Washington Acute Venous Thromboembolism (VTE) Deep Venous Thrombosis (DVT) Pulmonary Embolism (PE)
More informationThe management of venous thromboembolism has improved. Article
Comparison of 10-mg and 5-mg Warfarin Initiation Nomograms Together with Low-Molecular-Weight Heparin for Outpatient Treatment of Acute Venous Thromboembolism A Randomized, Double-Blind, Controlled Trial
More informationDOI: /chest This information is current as of September 15, 2005
Deep Venous Thrombosis in Patients With Acute Pulmonary Embolism: Prevalence, Risk Factors, and Clinical Significance Philippe Girard, Olivier Sanchez, Christophe Leroyer, Dominique Musset, Guy Meyer,
More informationWhat You Should Know
1 New 2018 ASH Clinical Practice Guidelines on Venous Thromboembolism: What You Should Know New 2018 ASH Clinical Practice Guidelines on Venous Thromboembolism: What You Should Know The American Society
More informationDiagnosis of Venous Thromboembolism
Diagnosis of Venous Thromboembolism An Educational Slide Set American Society of Hematology 2018 Guidelines for Management of Venous Thromboembolism Slide set authors: Eric Tseng MD MScCH, University of
More informationThe diagnosis and prognosis of venous thromboembolism : variations on a theme Gibson, N.S.
UvA-DARE (Digital Academic Repository) The diagnosis and prognosis of venous thromboembolism : variations on a theme Gibson, N.S. Link to publication Citation for published version (APA): Gibson, N. S.
More informationMagnetic resonance direct thrombus imaging of the evolution of acute deep vein thrombosis of the leg
Journal of Thrombosis and Haemostasis, 6: 1087 1092 DOI: 10.1111/j.1538-7836.2008.02986.x ORIGINAL ARTICLE Magnetic resonance direct thrombus imaging of the evolution of acute deep vein thrombosis of the
More informationEpidermiology Early pulmonary embolism
Epidermiology Early pulmonary embolism Sitang Nirattisaikul Faculty of Medicine, Prince of Songkla University 3 rd most common cause of cardiovascular death in the United States, following ischemic heart
More information